Ramblings of an Emergency Physician in Texas

Yeah, I’m alive

I’m in one of those phases where feeding the blog is a) not a priority and b) a potential liability, so it’s one of those things.

It’s not that I don’t like all 9 of you readers, I do. It’s just that with the repeal of the 24 hour day I have less time to get work/family/TV/CME/all that other stuff in. 2/3 of my kids have been home for a while, it’s been terrific, and tomorrow I go down to 1/3, keeping the lawyer. Go ahead, tick me off, and find out what having a temporarily unemployed lawyer at the other end of a complaint feels like. He’d like me to tell you that’s a joke, so it is, because he says it is. That’s what a decent legal education gets you.

My medical practice is smooth, and I’ve given a couple of talks to groups recently, so that’s fun. I talked for medical CME about whether non-contrast of the abdomen is ready for ED use (short version, no), and it was decently well received; yesterday I spoke to a nursing CME conference, ditto.

If you’re an ED doc and you haven’t at least looked at how to manage patients who come to your ED with a ventricular assist device, catch up. They are no longer locked up in the CCU, they’re now being sent home with them. This wouldn’t be a problem except they break a lot of rules… like no CPR if pulseless, etc, and some of these are designed to be pulseless. You can see the problem.

As for the liability, I’m getting more leadership/responsibility roles, but middle management types can’t blog those. Paul Levy can, as a CEO, but nobody in the middle can, and it makes sense to me. Lacking amazing stories of management (and I wonder if there are any), nada to blog about. Hold your breath for the reports from my addition to the hospital Bylaws Committee. Yeah, crazy stuff.

On a professional note, I’d like to alert all me ED colleagues that apparently a) jeans are no longer pre-washed before sale b) adolescent females don’t wash them before wear, and c) you’ll see patients in the ED with inexplicably warm yet blue extremities. Connect the dots, win a prize. I’ve picked up 3 of these recently (that have seen other docs who haven’t connected the dots), and have added alcohol-preps to my skin exam in select cases. Awkward diagnosis, and rewarding. (The key is warm, blue extremities but the skin discoloration skips the ‘between the digits’ areas).

Comments

Wait, wait, wait… Girls are coming to the ER because they find their legs stained blue from their brand new jeans?? Did I miss the joke or are you guys breeding a new brand of stupid down there in TX? OTOH, I did have a patient come in b/c of a “lump” – she had just found her cervix!

Had that twice back in the early ’80s: blue legs on a young woman, puzzled briefly til I noted the wet jeans
she had on (raining) and alcohol wipe lead to much shagrin. Other case was young girl with red forearms wearing
a red long sleeve shirt. Hasn’t happened since then, but there is always the infant with the red stool after
red gatorade.